why change hedis - health care accreditation, health plan
Post on 06-Jun-2022
4 Views
Preview:
TRANSCRIPT
The Future of HEDIS®: Digital Measures and Health Equity
February 24, 2021
Agenda
WHY CHANGE HEDIS
WHAT WE’RE CHANGING IN HEDIS
NEW IDEAS ON ECDS REPORTING
HEDIS AND HEALTH EQUITY
Q&A
Peggy O’Kane
Why Change HEDIS
Why change HEDIS
Less QM, more QI
Take advantage of delivery system capabilities
4
Our aim
Greater utility of HEDIS at point of care
Integrity of measurement throughout the system
Always on our minds...
The digital future
Moving from measurement to improvement
How data informs what we do
6
Changes will be steady
A process, not an event
Collaboration, not commands
Purposeful, not rushed
This will be along journey
More webinars and dialogue to come
8
If you remember only 1 thing from today...
HEDIS Public CommentOpen until March 11
ncqa.org/PublicComment
Michael Barr
What We’re Changing in HEDIS
1010
FLEXIBILITYAllowable Adjustments
ACCURACYLicensing & Certification
EASEDigital Measures
INSIGHTECDS Reporting
TIMESchedule
Change
ACCESSTelehealth
The Future of HEDIS
See our Future of HEDIS webinar series:
https://www.ncqa.org/hedis/the-future-of-hedis/
6 themes
11
FLEXIBILITYAllowable Adjustments
The Future of HEDIS
6 themesAllowable Adjustments
To give you flexibility in how you use our measures, we'll tell you their allowable adjustments.
11
12
The Future of HEDIS
6 themesLicensing & Certification
We’ll make sure uses of our measures are accurate and reflect quality of care.
ACCURACYLicensing & Certification
12
13
The Future of HEDIS
6 themesDigital Measures
We’ll give you measures in a digitalformat that’s easier to work with.
EASEDigital Measures
13
14
The Future of HEDIS
6 themesECDS
A new reporting method helps clinical data create insight.
INSIGHTECDS Reporting
14
15
The Future of HEDIS
6 themes
TIMESchedule
Change
Schedule Change
We now release HEDIS specs earlier to give you more time each year.
15
16
Schedule ChangeTIME
Schedule Change
HEDIS MY 2020 HEDIS MY 2021 HEDIS MY 2022
Publish Vols. 1 & 2 7/1/2020 7/1/2020 8/1/2021
Publish Vol. 2 Technical Update 10/1/2020 3/31/2021 3/31/2022
First Year Public Reporting 10/1/2020 10/1/2021 10/1/2022
Complete HEDIS Vendor Certification (Survey)
12/15/2020 12/15/2021 12/15/2022
Complete HEDIS Vendor Certification
2/15/2021 10/1/2021 7/1/2022
Data Submission Due 6/15/2021 6/15/2022 6/15/2023
17
The Future of HEDIS
6 themes
ACCESSTelehealth
Telehealth
Align. Adapt. Innovate.
See recommendations of ourTaskforce on Telehealth Policy: ncqa.org/telehealth
17
Fern McCree, Senior Health Care Analyst
Roadmap for Electronic Clinical Data Systems Reporting Method
Better accountability at all levels
19
NCQA’s Vision for Quality Measurement
Programs use better measures
Measures move beyond visit counts and low-bar process
New data sources, improved content and flow
Measure harmonization across programs
Meaningful, patient-specific measures
Standardizedelectronic data
Standardized, machine readable logic (CQL)
Writing specifications in clinical quality language (CQL) – “digital measures”
Evaluating measures for Electronic Clinical Data Systems (ECDS) reporting
Moving towards greater use and sharing of standardized electronic data across providers and systems
20
Transitioning digital measures to the FHIR-CQL data model
NCQA’s Digital Measures Roadmap
What Are Digital Quality Measures (dQMs)?
21
Easier transfer of measures into your IT system
Reduce interpretation, recoding, human error
Standardize to ease use across care continuum
dQMs are machine-readable, i.e., written as computer code
dQMs available for MY 2020/2021:
8 digitized versions of existing measures reported using
traditional methods
11 specified for ECDS reporting
NCQA is moving to FHIR®!FHIR-CQL measures to be released in Fall 2021
22
Fast Healthcare Interoperability Resources (FHIR) - interoperability standard that aligns quality measurement with other use cases
Aligns with the direction of other key stakeholders
2020 2021 2022 2023
Plan to release 22 dQMs in FHIR-CQL in Fall 2021 (Measurement Year 2022)
Proposed New dQMs • Follow-Up After Emergency
Department Visit for Mental Illness • Risk of Continued Opioid Use • Childhood Immunization Status
Released 5 draft FHIR-CQL HEDIS measures in November 2020• Intended for education and
information gathering only
Electronic Clinical Data Systems (ECDS)
A structured method to collect and report electronic clinical datafor HEDIS® quality measurement and for quality improvement
Reporting standard for HEDIS
For more information on ECDS: http://www.ncqa.org/ecds
To qualify, data must use standard layouts, meet the technical specifications and be accessible by the care team upon request
Organizations report each measure component by source system of record
Admin/Enrollment
PHREHR
Case Management
Clinical Registry
HIE
23
Measures Currently Available for ECDS reporting11 measures available for ECDS reporting for MY 2020/2021
24
8 Measures Originally Introduced into HEDIS with ECDS Reporting
3 Existing HEDIS Measures specified for ECDS Reporting
Available for optional ECDS reporting alongside administrative and hybrid
• Prenatal Immunization Status • Adult Immunization Status • Depression Screening and Follow-Up for Adolescents and Adults • Utilization of the PHQ-9 to Monitor Depression Symptoms for
Adolescents and Adults • Depression Remission or Response for Adolescents and Adults • Unhealthy Alcohol Use Screening and Follow-Up • Prenatal Depression Screening and Follow-Up • Postpartum Depression Screening and Follow-Up
• Breast Cancer Screening • Follow-Up Care for Children Prescribed ADHD Medication• Colorectal Cancer Screening
Stakeholder engagement
25
ECDS Goals and Strategy
Inform pace Improve uptakeHealth plan interviewsState/panel presentationsPublic comment
Quantitative analysis of ECDS results
Learning collaborativesAdd more measures to ECDS reporting
Digital Measures Roadmap
Overall support for ECDS reportingPrioritize screening and immunization measuresProvide additional resources to support adoption
Increased number of plans reporting ECDSIncreased use of HIE, registry, EHR data sourcesChallenges exchanging behavioral health information
Gained insight into strategies for data sharingEncouraging results for dual reported measures
What’s Next for ECDS Reporting?
26
Proposed Transition to ECDS Only Reporting for:
Current PublicationMY 2020/2021
Next PublicationMY 2022 MY 2023 MY 2024
Optional ECDS reporting alongside
Admin
Permit plans to choose ECDS or
Admin
ECDS onlyAdmin removed
Breast Cancer Screening
ADHD Medication
Colorectal Cancer Screening
Optional ECDS reporting alongside
Hybrid
Permit plans to choose ECDS or
Hybrid
ECDS onlyHybrid removed
27
Breast Cancer Screening Follow-up Care for Children Prescribed ADHD Medication Colorectal Cancer Screening
Proposed Measures for ECDS Reporting
Stakeholder interest in preventive care and immunization measures
Information well-captured in structured data
When What Why
MY 2022
MY 2023
Potentially allow optional ECDS reporting for additional measures:• Childhood Immunization Status1
• Immunizations for Adolescents1
• Metabolic Monitoring for Children & Adol. on Antipsychotics2
• Cervical Cancer Screening1
1Traditionally reported administrative or hybrid2Traditionally reported administrative
28
Enhance and replace existing measures using ECDSLooking Ahead
Better measures that leverage clinical data captured during the course of care
ECDS Reporting Roadmap
29
Supporting ECDS Adoption
Resources
Report summarizing stakeholder feedback on the ECDS reporting standard Coming soon!
Toolkit highlighting best practices in ECDS reportingComing soon!
Quality Innovation Series: Digital Quality, Measurement and Reporting• 4-6 virtual sessions; 1 session will highlight lessons learned from ECDS reporting• Sign up to receive additional information: https://www.ncqa.org/qiseries/savethedate/
Digital Measurement Community (DMC)Learn and Collaborate
30
Sharing Best Practices - To promote quality and accountability in the field
Education - To facilitate the adoption of digital measures and related standards
Collaboration - Collaborating to build a vibrant digital measurement community
To sign up, visit:www.ncqa.org/dmc
Public Comment
• Proposed timeline for removing traditional reporting from measures currently specified for ECDS.
• Suggestions on measure concepts that would be well-suited for future ECDS reporting.
• How can NCQA further support adoption of the EDCS reporting standard?
ECDS Reporting Roadmap
32
Public comment runs until March 11, 2021https://www.ncqa.org/about-ncqa/contact-us/public-comments/
Rachel Harrington, Research Scientist
Introduction of Race and Ethnicity Stratification into Select HEDIS Measures
34
Equity is in our mission
NCQA exists to improve health care.
High quality care is equitable care.
Inequitable care islow qualitycare.
35
Related, but not InterchangeableClarifying Terms and Concepts
Health Equity
Health Disparities
Social Determinants
of HealthSocial Risks
Social Needs
36
Health Inequity: Racial and Ethnic Disparities
Systemic RacismStructural & Institutional
Interpersonal RacismExplicit Bigotry & Implicit Bias
Social Determinants of HealthConditions where people are born, grow, live, work, play, and age
that affect health risks and outcomes
Racial/Ethnic Inequities in Health CareDisparities in availability, access to, and quality of health care
Racial/Ethnic Inequities in Health OutcomesDisparities in burden of illness, injury, disability, or morbidity
Health Care SystemsAmbulatory, Inpatient, Outpatient, Long-Term
Services and Support
An Example
37
Where are we now?
EQUITY AND SDOH IN EXISTING NCQA EFFORTS
38
Equity & SDOH in Existing NCQA Programs
Assess SDOH at population level and individual
level
Requires CLAS programming
and addressing disparities
Collection of SDOH at the
individual level
39
Equity & SDOH in Current HEDIS Measures
Four measures stratified by socioeconomic status (Medicare Advantage)
Comprehensive Diabetes Care
BreastCancer
Screening
Colorectal Cancer
Screening
All-Cause Readmission
Two descriptive measures of race, ethnicity and language of membership
Race/Ethnicity Diversity of Membership Language Diversity of Membership
40
Resources for StakeholdersTackling social determinants and health equity
Developed with support from Janssen Scientific Affairs, LLC
Resource Guidencqa.org/white-papers/sdoh-resource-guide
PolicymakerPerspectives
blog.ncqa.org
41
Where are we going?
PUSHING EQUITY TO THE FOREFRONT OF QUALITY
Health Equity
Pathway towards Health Equity Efforts to drive improvement
42
Standards and Programs
Measures Evaluation
Research, partnerships, technology, policy, stakeholder engagement
Provide a roadmap Create transparencyDefine targets and
methods for accountability
High quality care is equitable care
Public CommentProposal for Race/Ethnicity Stratifications in HEDIS
43
Public comment runs through March 11, 2021https://www.ncqa.org/about-ncqa/contact-us/public-comments/
• Specification for race/ethnicity stratifications• Definition of race and ethnicity categories• Acceptable source and method for imputation with
indirect data• Decision criteria for use of direct or indirect data source• Data reporting structure
• Proposed list of measures
Definition of race and ethnicity categoriesCurrent HEDIS Approach
44
Proposal:Apply approach currently used in
descriptive HEDIS measure.
Stratify Race and Ethnicity separately
for purpose of reporting
45
Insights from current HEDIS measureCompleteness of Race and Ethnicity Data
Commercial
Medicaid
Medicare
0% 20% 40% 60% 80% 100%
Race
Ethnicity
Both
Proportion of Plans With Data on ≥ 80% of Members
Sources for Race/Ethnicity Data
Direct
Alternatives for Measurement
Indirect
Individual self-reported information:
• Health plan enrollment data (claims-based measures)
• EHR data (electronic clinical data systems measures)
Imputation from secondary sources:• Assignment by geographic location
(characteristics at zip code, census block, e.g. Census, ACS)
• Surname analysis & imputation
Race & ethnicity can be collected either directly or indirectly.
46
Advantage: various methods, broadly accessibleChallenge: lower precision, lag in data
Advantage: gold standard accuracyChallenge: inconsistent collection, lack of standardization, technical concerns
Data Source and MethodsProposed Bridging Strategy
47
MY 2022 MY 2023 MY 2024
All Plans: Direct(potential indirect supplement)
Plans meeting 80% completeness: Direct onlyAll other plans: Indirect only
Provides bridge from where we are to where we want to be (direct)
Gives plans time to improve direct data collection
Ensures consistent level of data validity/completeness in years 1 and 2
Use of Indirect Data
Bayesian Indirect Surname and Geocoding (BISG) 1,2
• Statistical imputation using surname and geographic data
Allowed Methods and Sources
48
1. Elliott et al. (2008). A New Method for Estimating Race/Ethnicity and Associated Disparities Where Administrative Records Lack Self-Reported Race/Ethnicity. Health Services Research, 43, 1722–1736.
2. Haas et al. (2019). Imputation of race/ethnicity to enable measurement of HEDIS performance by race/ethnicity. Health Services Research, 54(1), 13–23.
Proposal: Allow reporting with indirect data using specific defined methods
Geographic Assignment• Assign race/ethnicity based on most common value at
given geographic unit (census tract)
Potential Technical Approaches Proposed Options for Public Comment Feedback
49
Option 1: Direct Data Completeness Threshold at Measure Level• Reporting using direct data allowed if measure-specific denominator
population meets data completeness threshold (80%).• The same plan may report different measures using different data sources (ex.
Measure A: Direct, Measure B: Indirect)
Option 2: Direct Data Completeness Threshold at Plan Level• Reporting using direct data allowed if data completeness threshold (80%) met
across plan enrollment in order to report stratification for all measures.• The same plan reports all measures using the same data source (ex. Measure
A: Direct, Measure B: Direct)
Measure Selection Process for Stratification
Measure stratification timeline:• Target of 5 measures stratified for MY 2022• Minimum of 15 measures stratified by MY 2024
Criteria for selecting initial measure set:
Timeline and Criteria
50
• ECDS/Digital• Risk-Adjusted Measures• First Year Measures• Slated for Retirement• Small Denominators
Exclude Prioritize• High priority for disparities• Represent multiple HEDIS domains • Represent multiple product lines
10 potential candidate measures identified for MY 2022
51
Candidate Measures for StratificationProposed Measures for Public Comment
Domain Measure Commercial Medicaid Medicare
Effectiveness of Care
Controlling High Blood Pressure (CBP) X X XComprehensive Diabetes Care (CDC)
• HbA1c Control <8%X X X
Comprehensive Diabetes Care (CDC)*• Eye Exam
X X X
Antidepressant Medication Management (AMM) X X X
Follow-Up After ED Visit for People With Multiple High-Risk Chronic Conditions (FMC)
X
Access and Availability of Care
Adults’ Access to Preventive/ Ambulatory Health Services (AAP)
X X X
Prenatal and Postpartum Care (PPC) X X
UtilizationWell-Child Visits in the First 30 Months of Life (W30) X X
Child and Adolescent Well-Care Visits (WCV) X X
Mental Health Utilization (MPT) X X X
* Separate measures, if approved for MY 2022
How HEDIS Measures are ReportedData Collection and Evaluation
52
Reporting elements
calculated by plan at plan level
Data reported to NCQA by plan at
plan level
Data collected by plan at patient
level
NCQA evaluates data at plan level
53
Summary of Proposal for Public CommentRace & Ethnicity Stratifications in MY 2022
• Align race and ethnicity categories with existing HEDIS definitions• Path for reporting using of both direct and indirect data
• Allow direct data for reporting if an 80% completeness threshold is met(two options for defining completeness)
• Allow indirect data for reporting using pre-specified methods• Timeline for transition to direct data requirement
• Ten measures identified for potential stratification, targeting five for MY 2022
Public comment runs until March 11, 2021https://www.ncqa.org/about-ncqa/contact-us/public-comments/
Questions
Public Comments Weigh in on changes to NCQA products and programs.
To see a list of products available for public comments, visit Open Public Comments
Digital Measures: Updates on reporting Electronic Clinical Data System (ECDS) measuresHealth Equity: Introduction of Race and Ethnicity Stratification Into Select HEDIS Measures
How to Submit Comments after today’s Q&AHEDIS Public Comment: Feb 11-March 11, 2021
Submit comments at my.ncqa.org
Public Comments
top related